Coming Full Circle and Nursing Again

Breast cancer influenced my nursing timeline three years ago.  Having the opportunity to nurse a new baby has lessened the sadness surrounding that weaning.  Nursing was always such a large part of mothering for me.  Breastfeeding is more than food;  it is warmth, comfort, reassurance, love, and more.

As a new baby, she didn't realize that she can’t nurse on both sides.  She would try to latch onto anything and often would try to nurse though my shirt on whichever side I held her.  I am conscious that I only nurse her on one side and try to hold her and have her sleep on my other side occasionally.

I am fairly protective of my remaining breast.  Because I only have one, I had concerns about not being able to switch sides during a big growth spurt or even with sore nipples.  For the most part breastfeeding on one breast has been an easy task.  It is interesting to never need to switch sides and never wonder which breast I used last.

Chiropractic care has helped us both stay more even with the one-sidedness.  Having a sore nipple is unique in that I can't know if it's occurring on both sides or not as there's only one.  This is especially true for soreness due to hormonal changes.  With two nipples, there is confirmation that the soreness is "normal" and on both sides.  Probably the biggest challenge was developing mastitis at six months. It was rough and nursing through it was the best option.  It certainly would have been nice to have two breasts then!

Through my volunteering as a lactation counselor and my personal experience of nursing two other children, I know that breastfeeding is all about supply and demand.  I have seen twins nurse successfully.  I know nursing on one breast is possible, but seeing it is amazing.  I marvel that my body works so well and my baby thrives on just my milk.

As my baby turns into a toddler, I love that nursing is still a part of our lives.  I see how important it is to her.  She knows there's only one breast and nipple and it's just fine with her.

Becoming Pregnant

When I was diagnosed with breast cancer just over two years ago, I wondered if I would ever be pregnant again.  As treatment options became reality, it seemed less and less likely.  Now I am pregnant again and it seems so normal, yet so long ago that I felt like this.  It was a lifetime ago, but only 5 and a half years ago. 

Having a cancer grow inside your body feels so foreign and is something so unwelcome.  Becoming pregnant is taking back some of that control, though trying to get pregnant is another lesson in lack of control.

Feeling my remaining breast swell and do what it is supposed to do is so normal.  Growing a healthy, normal baby again is so fulfilling.  

I feel tremendously lucky that I have no evidence of disease and am able to be pregnant.  If I had had a hormone receptive cancer, I would likely still be taking Tamoxifen and not pregnant.

Even though I feel like a breastfeeding expert, I do have some concerns about nursing on only one side.  There isn't much information available for women who find themselves breastfeeding after a mastectomy.  What if my nipple becomes damaged?  What if she seems to need more?  Even though I know that through the perfect system of supply and demand, she will have just enough.

Being older and post cancer treatment certainly has made this pregnancy a bit harder than my others.  I started at a higher weight and did have some concerns about being 37 years old.

Already having a six year old and a ten year old brings many people to pause.  Why the big space in my family?  Do I really want to “start all over again?”  Watching a baby grow and develop is an awesome experience, seeing it through my older childrens’ eyes is even more so.  I know what to expect in some instances, but for them it’s like magic.

Ultimately choosing to have another baby and being able to was the best decision for me.  It has been healing to see my body function more normally.

Finishing Herceptin and Cancer Treatment

The new normal:  what life following a cancer diagnosis is often considered.

My life which used to be filled with toddler music class, story time at the library, shuttling to karate classes, visits with friends, the zoo, and the children's museum had been replaced almost entirely with doctor visits, IVs, fatigue, and a general sense of being distracted.  I read cancer magazines, books about cancer, and participate on a message forum for young women diagnosed with breast cancer.  I have scars and lots of doctors.

As my appointments began to space out and I neared my final Herceptin, I read about how patients often feel happiness mixed with some sadness.  The cancer experience is a busy one mixed with not feeling great.  Not much else goes on, even in one's mind. The patient is the center of attention at each appointment.

For me, I was ready to be done and have my days back, though it felt a little strange knowing I would have no plans to go back and get more IVs.  It had become such a normal activity for me.  I looked forward to feeling myself again and losing the gained weight.

It really wasn't until I was feeling rested and done with treatment that I realized how fatigued I had been. I hadn't stopped all our activities at once, they were slowly dropped. I had to try to remember what we had done with our days.  I was ready to sign up for activities again and find our friends we hadn't seen.

The Golden Token

So much like a quarter, similar in size and weight, I even keep it in my wallet. Its presence carries hidden meaning. This unique token is for the “special” parking lot at the cancer center. It grants me entrance to a small lot near the cancer center, a branch of the hospital. After my first visit, the receptionist asked if I’d ever be back. I answered yes, I’d be back and she gave me my first token. Since then, I’ve always had at least one golden token in my wallet waiting to gain access to the special parking lot. Sometimes when looking for change, I spot the golden token and remember when I’ll need to use it again. I don’t know when I’ll be done having golden tokens in my wallet. I’ll need them for my follow ups with my oncologist pretty regularly for at least two years. I imagine I’ll see her at least annually for a long, long time. It’s amazing how something as ordinary as a coin can hold such meaning for me. It signifies cancer and how it is now a part of my life.

Follow-ups, Follow-ups

My first reaction at the mention of cancer was sadness that I would need to go to more doctor appointments.  I don't think I could have imagined how many appointments I would actually need to attend.

Before even starting chemo, I needed to have an Echocardiogram to check on my heart.  I was to receive Herceptin which can sometimes cause cardiotoxicity and effect the ejection fraction of the heart.  After this initial check, I would continue to have checks every three months during the year of Herceptin treatment and a final follow up.

In making the many decisions for chemo treatment, surgery, radiation, and plastic surgery, I found it helpful to be as educated as possible.  Part of my education came from seeking multiple doctor opinions.  Not only did they present different opinions sometimes, they also talked about treatments in different ways.  I really appreciated having the opportunity to meet with so many talented doctors.

Once I was locked into a treatment, I would have regular appointments at predetermined intervals.  Pre-Ops and Post Ops, then every three months, every six months, finally annually.  These regular appointments were with the breast surgeon, the plastic surgeon, the medical oncologist, and the radiologist at the breast imagine center.

For chemo, I had twelve weekly treatments of Taxol and Herceptin.  Before each treatment, I would need to have a blood draw.  Often patients are scheduled to have a blood draw and then wait an hour, then receive treatment.  Because I wanted to minimize my time away from my toddler, I opted to have a blood draw in the morning with my toddler in tow, and return later to have my chemo.  After completing the twelve weeks, I continued receiving Herceptin regularly for another nine months.  Initially, I received it every week, then I switched to every three weeks of a higher dose.

Recovering from Breast Reconstruction Surgery

The surgery lasted four hours, that was the best case scenario.  I didn't realize that I would not be able to eat or drink for another 24 hours after the surgery.  This is a precaution in case I needed to head back into surgery.  I am tired and not interested in the pain medications they are offering.  I don't notice much difference in my pain, which is little, but I am hypersensitive to everything.  With the morphine, I am regularly startled by the things going on around me.

Day 2 
I am allowed a liquid only diet.  I still feel quite nauseous from the anesthesia.  It comes and goes though.  I have a local anesthetic pain pump for my leg incision which I guess is working ok.  My breast area is numb and pretty comfortable.  I feel some discomfort in the muscle at times.  One of the sore spots I keep noticing is at my sternum.  The doctor needed to cut a bit of my rib at the sternum in order to connect the blood vessel.  I have a broken rib and it feels broken.  I don't like the narcotics and have requested only Tylenol.  I am able to walk around and get to the bathroom ok.  

Day 3 

Finally some food!  I still feel bits of nausea, but food helps.  I have been ok'd to add Ibuprofen alternating with Tylenol.  Passing the 48 hour window of recovery means the flap is probably going to be just fine.  The doppler checks are spaced out and it looks like I will be leaving tomorrow on schedule.

Day 15 post op

Day 4-10
I am healing and walking around the block and feeling well.  From time to time I feel exhausted and need to rest.  My surgical areas are healing well, though I still need the three drains though.  On day 10, it's time for Herceptin again and it goes well.

Day 16
Had my "2 week follow-up" at the plastic surgeon's office.  It is still recommended that I restrict my lifting another week or so.  I can move from no bra to wearing a stretchy bra with no cup.  They still recommend keeping the donor area of my thigh wrapped in an ace bandage for compression for another one to two weeks.  There are more sensations coming back to the breast area and I have a hard spot above.  Physical Therapy would be a good idea down the road.  At home I walk twice around my neighborhood totaling 1.2 miles.  My gait is normal, the pace is getting faster, almost normal.  My daily schedule is getting more normal as well.  I can go to my appointment, the library, visit a friend and no longer need an afternoon nap.

Surgery #2 - TUG Flap Reconstruction

My surgery will entail a mastectomy. While my general surgeon is doing that, the plastic surgeon (ps) will be removing skin, tissue, fat and the gracilis muscle from my inner thigh. He will cut the blood supply and prepare it to become a breast mound - that is what they call it. After the mastectomy (removing all breast tissue, nipple, and areola), my general surgeon will leave. The mastectomy will take about an hour. The plastic surgeon takes over now. He will spend the next 3 hours doing microsurgery to reattach the blood vessels, create the illusion of a breast and sew/glue everything back together. The total surgery should take about 4 hours.

After surgery I will be in the ICU or a step down from the ICU. This is only because the new breast needs to be monitored every 1-2 hours for two days. The temperature, pulse, and color will be carefully observed. I have been told that the minimum hospital stay for this procedure is three nights. I will be having a pump of local anesthetic pumped into my thigh for pain relief. I will also have IV pain medication. Though many people do not report as much pain in the breast area because all the nerves have been cut.

At my pre-op appointment today I learned more about anesthesia and what drugs are used for that. I will be fully asleep, my muscles will be realaxed and I will have a ventilator for breathing and bringing in gas anesthesia. As always, I feel more comfortable and confident with more information.

I feel confident in my two surgeons and will allow my body to be changed by them. I will also make a conscious decision to allow the medications to come into my body and do what they are supposed to do.